Have you been convicted of a felony which has not been expunged, annulled, or sealed by a court?

Yes

No

Were you previously employed by Families Living Violence Free?

Yes

No

If yes, please explain.

Did you graduate high school?

Yes

No

Name of high school

City, State, andZip

Did you graduate college?

Yes

No

Name of college

City, State, and Zip

Major

Skills and Qualifications: Please list any certifications, credentials, training, affiliations, and awards which are relevant to the job-skills of the position for which you are applying.

Are you available to work

Full Time

Part Time

Employment History

NOTE: Please complete ALL sections in full (Do not attach resume in lieu of completing this section)

Employer Name and Address

From

To

Title

Supervisor

Phone Number of Employer/Company

Starting Salary

Ending Salary

List Primary Responsibilities

Reason for leaving

Employer Name and Address

From

To

Title

Supervisor

Phone Number of Employer/Company

Stating Salary

Ending Salary

List Primary Responsibilities

Reason for leaving

Employer Name and Address

From

To

Title

Supervisor

Phone Number of Employer/Company

Starting Salary

Ending Salary

List Primary Responsibilities

Reason for leaving

May we contact your present employer?

Yes

No

Professional References (Please list names and telephone numbers )

1. Name

Phone Number

2. Name

Phone Number

3. Name

Phone Number

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I understand that any falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I authorize a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons and corporations requesting or supplying such information. I hereby agree to submit to any lawful drug or background screening that may be required as a condition of employment or continued employment. I understand that all offers of employment are conditional upon the successful completion of the testing and screening procedures and that refusal to submit to such testing during the course of my employment may result in disciplinary action, up to and including discharge. I understand and agree that my employment and compensation are terminable at- will either at my option or at the option of FLVF, that I am not being employed for any specified time, and that this application is not intended to be a contract for continued employment.